Irritable Bowel Syndrome – IBS Awareness Month

April is IBS Awareness Month and we thought it was a good time to pull together a comprehensive article summarising some of the information around irritable bowel syndrome (IBS) to support those who might already have it or might be concerned that they have some of the symptoms.

We have written a number of posts on IBS over the past couple of years and have a number of research studies into the effect of friendly bacteria on IBS symptoms. In this post, we bring all this information together.

What is IBS?

Irritable bowel syndrome is a common disorder that affects the large intestine, characterised by abdominal pain, bloating, gas, diarrhoea, constipation or both. It is a chronic (or long-term) condition, diagnosed when all other possibilities have been ruled out.

The Rome Criteria are used for diagnosing IBS and are based upon abdominal pain lasting at least one day a week in the last three months in association with two or more of:

• Pain and discomfort related to a bowel movement
• Changes in frequency of defecation (either less or more)
• Alterations in your stool consistency

As well as other gut symptoms such as easily feeling full, loss of appetite, bloating, flatulence, belching, nausea and heartburn, IBS can also cause non-gut-related symptoms, such as fatigue, headaches, muscle aches, brain fog, anxiety and other emotional issues.

IBS is divided into three different types:

• Constipation dominant (IBS-C)
• Diarrhoea dominant (IBS-D)
• Mixed bowel habits, both constipation and diarrhoea (IBS-M)

Up to 20% of people in the UK have IBS and symptoms usually first appear between the ages of 20 and 30. It is also more common in women, with double the number of women than men being diagnosed with IBS – although this may be due to under-diagnosis in men who are less likely to visit their doctor for symptoms.

IBS symptoms tend to come and go and are often linked with stress and other lifestyle changes. As there is no test to officially confirm it, tracking symptoms is important in its diagnosis.

Potential triggers for IBS

The precise causes of IBS are unknown and it has been linked to a number of potential triggers, including problems with digestion, gut infections, food sensitivities and genetic predisposition, as well as psychological and emotional trauma including chronic or excessive stress.

The triggers also vary from person to person and can change over time – they include both food-related and non-food-related triggers.

Food triggers
Different foods will affect different individuals and it is important to keep a food diary (with symptoms) to identify the potential triggers for your own IBS. Trying an elimination diet, with the support of a registered nutritional therapist, can help to identify any foods that may be exacerbating symptoms.

Some foods can exacerbate constipation in certain individuals – these foods include refined grains, processed foods, red meat, alcohol and dairy products.

Similarly, some people can be susceptible to diarrhoea from eating certain foods – including too much fibre (often from fruit), chocolate, alcohol, caffeine, fructose or some artificial sweeteners, carbonated drinks, large meals, fried and fatty foods, and dairy and wheat foods for those with intolerances.

Non-food triggers
Although irritable bowel syndrome can be related to food, there are a number of causes of IBS that are not food-related. Implementing strategies to manage these may help with reducing symptoms. They include:

Gut conditions
Several conditions and infections may contribute to IBS symptoms such as gas, diarrhoea and constipation. These can include small intestinal bacterial overgrowth (SIBO), gastroenteritis, dysbiosis (an imbalance of gut bacteria) or parasites.

Low stomach acid and digestive enzymes
As we get older our ability to produce stomach acid and digestive enzymes can fall, making it more difficult to digest our food and leading to IBS symptoms such as bloating, gas and heartburn. Some medications also impact stomach acid production.

Medications
Antibiotics, protein pump inhibitors (PPIs) and over-the-counter heartburn medications can all impact our digestion and lead to symptoms. Antibiotics, in particular, affect our gut bacteria and thus our gut function, whilst PPIs and heartburn meds lower stomach acid levels.

Drug use, smoking and alcohol
Heavy use of alcohol and cigarettes can result in heartburn, low stomach acid, constipation and/or diarrhoea, and bloating, all of which are symptoms of IBS. Long-term drug and alcohol abuse may also lead to more serious gut conditions.

Hormonal changes
Sex hormones, particularly oestrogen, have been linked to gastrointestinal symptoms as they affect the function of the GI tract. IBS is twice as likely to occur in women as in men. As a result, IBS has been linked to hormonal problems.

Sedentary lifestyle
Regular exercise can help to manage stress and to support our digestive function. Living a sedentary lifestyle may, therefore, contribute to a sluggish bowel and result in IBS symptoms such as bloating and constipation.

Dehydration
Water is essential for optimum digestion and is vital for both constipation and diarrhoea. Keeping well hydrated if suffering with constipation can prevent the stool becoming too hard or dry; if diarrhoea is a problem then drinking plenty is critical to replace any lost fluids.

Coping with IBS?

The causes of IBS are particular to each individual and we would always recommend working with your doctor or another health professional to get to the root cause for you. Whilst doing this, here are some ideas for helping to manage the various symptoms:

1. Managing stress is key as the body’s stress response switches digestion off. As a result, if we are continuously stressed our digestion cannot work optimally. Learning some relaxation exercises may help reduce our stress response – try deep breathing, meditation or simple yoga moves.
2. Food intolerances can also be a factor and identifying the foods that trigger symptoms in us as individuals and removing them from our diet can help to reduce symptoms. Foods such as broccoli, cabbage, Brussels sprouts, onions, garlic and beans can also trigger gas in some people. (See also FODMAPs diet at point 4 below)
3. Reduce alcohol, caffeine and spicy foods as they can irritate the intestinal lining and cause a reaction in some people.
4. Following a low FODMAPs diet may help to alleviate symptoms. Please note that this is not intended to be a permanent eating plan as it restricts certain food groups. Eliminating all FODMAPs and then testing the different groups with particular foods can help guide the diet going forward. FODMAPs are ‘fermentable oligosaccharides, disaccharides, monosaccharides and polyols’, carbohydrates that are increasingly being implicated in IBS. They include:

• Oligosaccharides – wheat, rye, legumes, and other fruits and vegetables, such as garlic and onions

• Disaccharides – milk, yoghurt and soft cheese

• Monosaccharides – fruits such as figs and mangoes, and sweeteners such as honey and agave nectar

• Polyols – some fruits and vegetables including blackberries and lychees, and low-calorie artificial sweeteners (anything ending ‘ol’)

5. Female hormones (oestrogen and progesterone) may be one of the reasons that women experience more IBS than men. These hormones affect how well our digestion works, how much pain we feel and can also impact inflammation throughout the body. Keeping them balanced can help to manage IBS symptoms.
6. Bacterial infections and gastroenteritis can sometimes lead to long-term gut issues and cause IBS symptoms.
7. Low digestive enzyme and stomach acid secretion will affect our ability to digest our food and absorb the nutrients they contain, potentially affecting our gut and health in general. Eating mindfully can help stimulate the natural production of these, or supplementation may be needed in some cases.
8. Adding friendly bacteria to your diet through foods such as sauerkraut, kefir and live yoghurt may help to balance your microbiome. If you feel these foods make your symptoms worse, try a friendly bacteria supplement.
9. Maintaining a normal diet and sleep routine when travelling can help to maintain digestive balance.

Finally, for everyday symptom relief, exercise regularly, eat small meals slowly, try sipping peppermint, chamomile or fennel tea or snuggle up to a hot water bottle.

Gut bacteria and IBS

People with IBS have been found to have an imbalanced microbiome. The microbiome consists of gut bacteria that help to break down the food we eat and to regulate bowel function, including motility, sensation and immune function.

A balanced gut bacteria – levels of beneficial and pathogenic bacteria in the right amounts – supports optimal gut function and health in general. This bacterial balance is influenced by many environmental factors, including diet, drugs, and lifestyle.

Recent studies have shown that an imbalance in gut bacteria (known as dysbiosis) may contribute to the development of IBS. This is supported by the fact that many people develop IBS following an episode of acute gastroenteritis, which affects the composition of the gut bacteria.

The increasing body of research showing the positive effects of prebiotics, probiotics, and diet on the symptoms of IBS would also suggest that the gut bacteria play a significant role and supporting bacterial balance may help to reduce symptoms.

Additional articles for IBS Awareness Month:

• Irritable bowel syndrome – Guts UK
  Irritable bowel syndrome (IBS) – NHS

Want to know more?
ProVen Probiotics aim to provide the best support for both you and your health. If you wish to know more about gut health and staying healthy please do not hesitate to call us on 01639 825107 or alternatively, learn more via our blogs or in-depth ProVen research.

ProVen Probiotics, Unit 2 Christchurch Road, Baglan Industrial Park, Port Talbot, SA12 7DJ. Tel: 01639 825107